精神科医师转岗培训教学实践探讨

为加强精神科医师培养工作，提高基层精神卫生服务能力，建立健全精神卫生体系，开展 精神科医师转岗培训至关重要。通过开展精神科医师转岗培训项目，从理论知识、临床实践、社区实践 等教学内容方面学习，同时从教师能力、教学理念、形式等教学模式方面进行优化，采用多种教学模式 相结合，穿插强化培训班以强化教学内容，并严格全面考核以评估培训效果。通过对精神科转岗学员 系统的培训，精神科转岗学员重点掌握了基本理论知识和临床基本技能，熟悉精神卫生工作服务模式， 达到胜任精神科医师岗位的基本要求，从而进一步完善各级医疗机构，尤其是县级医疗机构的精神科 医师培养，提高精神卫生服务的可及性，缓解精神卫生人力资源短缺的不足。     

精神科住院医师"五站式"客观结构化临床考核评分标准的信度分析

目的:探讨精神科住院医师"五站式"客观结构化临床考核(OSCE)的3个站点评分表的信度。方法:以广东省第三期精神科住院医生培训师资培训班115名学员为对象,先由指导老师针对OSCE中第二站"临床技能站"、第三站"临床思维站"、第五站"临床沟通站"评分标准逐项讲解和分析;然后安排广州市惠爱医院二年级住培医师对真实住院患者进行上述3个站点的现场测试,现场师资培训班学员对住培医师进行评分;其中学员对住培医师"临床沟通站"分别在指导老师现场讲解后及实例演练后进行两次评分,分析各次评分的组内一致性。结果:学员对住培医师"临床技能站"、"临床思维站"的现场评分一致性的组内相关系数(ICC)分别为0. 988、1. 000;"临床沟通站"现场讲解后及实例演练后两次评分ICC分别为0. 990及0. 998。结论:经培训的学员对精神科住院医师"五站式"OSCE考核评分一致性高,联合实例演练后再评分的组内一致性更好。     

消息

为贯彻执行省人事厅、卫生厅关于开展继续教育的精神,提高广大基层精神科医师的诊疗水平。为期6个月的临床精神医学进修班于2000年4月3日在四川省绵阳市精神卫生中心开学。来自四川、重庆、云南、河南等地30余名学员参加了学习。消息     

缺血性脑血管病介入治疗的培训模式研究——“卫生部脑卒中筛查与防治工程培训项目——颈动脉支架置入技术培训班”经验介绍

目的探讨缺血性脑血管病介入治疗医师培训的方法和模式。方法对首都医科大学附属北京天坛医院急诊介入科颈动脉支架置入术培训班学员进行理论学习和操作训练,培训后进行考核对培训效果进行检验。结果参与2013年1~2月第一批培训的学员共30名,年龄30~45岁,平均(35.0±6.8)岁。全部学员均完成了培训并进行了考核,理论考试全部通过,理论成绩平均(82.1±4.2)分;操作考核也全部通过,总分平均(80.3±6.3)分。结论个体化教学和统一教学结合进行理论和操作技术培训颈动脉支架置入手术学员收效较好。     

缺血性脑血管病介入治疗的培训模式研究

目的   探讨缺血性脑血管病介入治疗医师培训的方法和模式。 方法  对首都医科大学附属北京天坛医院急诊介入科颈动脉支架置入术培训班学员进行理论学习和操作训练,培训后进行考核对培训效果进行检验。 结果  参与2013年1～2月第一批培训的学员共30名,年龄30～45岁,平均（35.0±6.8）岁。全部学员均完成了培训并进行了考核,理论考试全部通过,理论成绩平均（82.1±4.2）分;操作考核也全部通过,总分平均（80.3±6.3）分。 结论  个体化教学和统一教学结合进行理论和操作技术培训颈动脉支架置入手术学员收效较好。     

开拓进取 壮志不已——记著名精神病学家刘协和教授

华西医科大学心理卫生研究所刘协和教授是当代中国著名的精神病学家之一。1928年生于湖南省衡阳;1955年毕业于湖南医学院医学系,同年赴四川医学院精神科任医师,历任教研室主任、研究室主任、大学图书馆馆长。1980年赴英国伦敦大学和牛津大学深造,并到美国、法国、比利时、瑞士等国考察,现为华西医科大学精神病学教授、博士生导师、心理卫生研究所所长。曾任中华医学会神经精神科学会常委,中华医学会精神科学会第一届常委,中华神经精神科杂志编委,中国心理学会理事,四川省心理学会副理事长,中华医学会遗传学会委员兼精神科学组组长,中国中西…     

急性缺血性卒中血管内治疗技术培训模式研究——急性缺血性卒中血管内治疗培训班经验介绍

目的 探讨培训介入医师急性缺血性卒中血管内治疗技术的方法和模式.方法 对中国卒中学会国际卒中介入培训学院,首都医科大学附属北京天坛医院主办的"急性缺血性卒中血管内治疗培训班"学员进行血管内治疗技术理论和实践培训,并通过实践工作后1年进行毕业答辩,对学员的培训成果进行检验.结果 完成培训并在实际工作中开展急性缺血性卒中血...     

新疆举办精神病学医师讲习班

新疆维吾尔自治区第一次举办精神病学医师讲习班,于今年3月23日于乌鲁木齐市正式开学。30多名学员来自各地区及州的医院,为不同民族的精神科及其它科的临床医师。聘清享有一定名望的教授或主任医师讲座,对提高精神病的防治工作起到更大作用。     

2014年四川省精神卫生服务机构、床位及精神科执业医师现状分析

目的了解四川省精神卫生机构和床位资源,以及精神科执业医师(含助理)分布情况。方法本调查由四川省精神卫生中心于2014年7月组织实施完成。首先编制"四川省精神卫生服务的机构调查表",下发各市州卫生局/精防机构填报;再编制"机构信息补充表"下发给被填报的相关机构人员填写;最后对全省开展精神卫生服务的机构,精神科核定床位及精神科执业医师(含助理)人数进行描述性分析。结果全省开展精神卫生临床服务的机构共138家,其中58.70%为专科医院,84.06%隶属于卫生系统。全省21个市州中阿坝藏族羌族自治州和甘孜藏族自治州尚无开展精神卫生服务的机构。全省181个区县中,50.83%的区县无精神卫生服务机构。全省编制床位19078张,每万人口编制床位2.37张;实际开放床位30241张,每万人实际开放3.76张。全省精神科执业医师(含助理)1756人,每10万人口2.18名精神科执业医师(含助理)。结论四川省各市州间精神卫生服务资源分布不合理。     

第25届全国精神科医师临床进修班和第8届全国精神医学研究进修班概况

金秋来临之际,我们刚送走第14届全国精神科医师临床进修班的学员,第25届招生工作又紧锣密鼓地展开了,这次共招收学员42名,他们来自全国各地二十多个省市,有江浙地区的,也有采自遥远的新疆、青海、云南等五个少数民族区。他们中男性28名(66.7％),女性14名,(33.3％);本科19名(45.％),大专16名(38.％);主治医师13名(30.5％),党员9(21.％)。有一定的精神科临床工作基础,总的来说,学员学历素质越来越高,年龄更趋年轻化。进修班第一阶     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.